Tag Archives: Healthcare attorney

Medical Staff Involved in Peer Reviewers Can Receive Compensatory and Punitive Damages for Violations of their Confidentiality: Part 1 of 2

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by the Florida Bar in Health Law and Shelby Root

6 Indest-2008-3An important decision was delivered by the Supreme Court of New Mexico involving peer reviewers’ statutory right to confidentiality. In the decision, the New Mexico court allowed peer reviewers to recover compensatory and punitive damages resulting from confidentiality violations. The court recognized that peer reviewers are members of the class protected by the peer review statute in New Mexico. Thus, the court stated, they deserve remedies for violations of their confidentiality right. To view the New Mexico Peer Review Statute, click here.

Yedidag v. Roswell Clinic Corp., the New Mexico Case.

Dr. Emre Yedidag was an employee of Roswell Clinic Corp. and Roswell Hospital Corp. During a peer review of another employee, Dr. Akbar Ali, Dr. Yedidag allegedly “verbally attacked” Dr. Ali when he questioned the physicians’ involvement in a patient’s death. The hospital subsequently terminated Dr. Yedidag’s employment for “unprofessional conduct.” In response, Dr. Yedidag filed a complaint against the hospital for utilizing confidential peer review information to support his termination.

The Supreme Court of New Mexico did not agree with the hospital’s argument that the physician’s unprofessional conduct justified the doctor’s termination. The court held that the doctor’s questions were privileged, even if they were “uncivilized.” Also, the court ruled, the hospital may not use information from a peer review proceeding as a reason to terminate his employment. The court upheld an award to Dr. Yedidag of his compensatory and punitive damages. To read the case in its entirety, click here.

The New Mexico Supreme Court Estimated that the Peer Review Statute is too Lenient.

The Supreme Court of New Mexico also estimated that the criminal penalty imposed by the New Mexico peer review statute was “too lenient” to discourage violators. Therefore, allowing peer reviewers to sue violators will result in greater deterrence, the court ruled. The court held that peer reviewers’ confidentiality is a “mandatory rule of law incorporated into physician-reviewer employment contracts.”

Comments?

What are your thoughts on the Supreme Court of New Mexico’s ruling of compensatory and punitive damages for peer review violations? Please leave any thoughtful comments below.

Contact a Health Law Attorney Experienced in Representing Health Care Professionals.

At the Health Law Firm we provide legal services for all health care providers and professionals. This includes physicians, nurses, dentists, psychologists, psychiatrists, mental health counselors, Durable Medical Equipment suppliers, medical students and interns, hospitals, ambulatory surgical centers, pain management clinics, nursing home and any other health care provider. We represent facilities, individuals, groups and institutions in contracts, sales, mergers and acquisitions.

To contact the Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

Source:

Stein, Alex. “Doctors Conducting Peer Review Can Recover Compensatory and Punitive Damages for Confidentiality Violations.” (February 21, 2015). From:
http://blogs.law.harvard.edu/billofhealth/2015/02/21/doctors-conducting-peer-review-can-recover-compensatory-and-punitive-damages-for-confidentiality-violations/

About the Authors: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620. Shelby Root is a summer associate at The Health Law Firm. She is a student at Barry University College of Law in Orlando.

Keywords: Yedidag v. Roswell Clinic Corporation, peer review, defense attorney, defense counsel, defense lawyer, medical staff attorney, fair hearing attorney, peer review fair hearing, clinical privileges attorney, hospital clinical privileges, confidentiality right, compensatory damages, punitive damages, New Mexico peer review statute, healthcare law, healthcare attorney, healthcare lawyer, The Health Law Firm

“The Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A. – The Health Law Firm, a Florida professional service corporation, since 1999.
Copyright © 1996-2015 The Health Law firm. All rights reserved.

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Government Discovers Extensive Overbilling of Cancer Drug to Medicare

Lance Leider headshotBy Lance O. Leider, J.D., The Health Law Firm, and George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

It’s no surprise that the government is aggressively pursuing Medicare fraud. Recently, the Department of Health and Human Services (HHS), Office of Inspector General (OIG), made a surprising discovery. An audit uncovered that more than three-quarters (3/4) of all Medicare claims for the breast-cancer drug Herceptin were billed incorrectly, according to Modern Healthcare. This was found during an audit conducted on physicians and hospitals from around the country between January 1, 2008, and December 31, 2010.

To read the entire Modern Healthcare article, click here.

Audit Results from Around the Country.

Three different audits were released to the public by the HHS OIG. All of these audits showed roughly the same information. Health care providers have been billing Medicare for full multiuse vials of the drug Herceptin, when patients actually only need a smaller portion. Medicare does not pay healthcare providers for any part of the drug that is discarded, because it can be preserved for up to 28 days and reused. The auditors suggest that payment from Medicare for an entire multiuse vial is likely to be incorrect. We saw a similar situation with the drug Avastin and Lucentis being used by ophthalmologists several years ago.

The results of the audits were released in January 2013. One audit found eighty-five percent (85%) of 1,073 Herceptin vials used in Ohio and Kentucky were billed incorrectly. In Illinois, Indiana, Michigan and Wisconsin, the government auditors found that seventy-eight (78%) of 713 claims investigated were wrong. The overpayment amount was around $682,000, for these audits.

Florida’s District Found to Have Overcharged 78% of Bills.

According to the report, HHS auditors found overcharges in seventy-eight percent (78%) of bills for 1,330 vitals of Herceptin submitted to First Coast Service Options, Inc. This company serves as the Medicare Administrative Contractor (MAC) for HHS District Nine, which primarily includes providers in Florida, Puerto Rico, and the U.S. Virgin Islands. The overcharges for Herceptin were $1,325,409.

In the report, the government recommends that First Coast Service Options, Inc., do a number of things. The first is to recover the more than one million dollars in overpayments. It’s also recommended that First Coast Service Options, Inc., implement system edits that review multiuse vial drugs that are billed with units of service equivalent to the dosage of an entire vial. The government also suggests that these audit results be used as an educational tool for teaching correct billing practices to physicians and hospitals.

Click here to read the entire report on District Nine.

How to Respond to a Medicare Audit.

Remember, there is no such thing as a “routine” Medicare audit. The fact is that if you find yourself or your practice at the center of a Medicare audit, there is some item you have claimed as a Medicare provider or the amount of claims Medicare has paid in a certain category that has caused the audit. We’ve come up with a list of actions that we use and recommend you take when responding to a Medicare audit. Click here to view that list.

Don’t Wait Until It’s Too Late; Consult with a Health Law Attorney Experienced in Medicare and Medicaid Investigations.

The best time to respond to and defeat an allegation of overpayment is at the very beginning. That is why it is essential that you obtain qualified counsel to help you through the process. The attorneys of The Health Law Firm represent healthcare providers in Medicare audits, ZPIC audits and RAC audits throughout Florida and across the U.S. They also represent physicians, medical groups, nursing homes, home health agencies, pharmacies, hospitals and other healthcare providers and institutions in Medicare and Medicaid investigations, audits, recovery actions and termination from the Medicare or Medicaid Program.


For more information please visit our website at www.TheHealthLawFirm.com or call (407) 331-6620 or (850) 439-1001.

Comments?

Why do you think hospitals and physicians incorrectly bill for Herceptin? Are audits like these necessary? Please leave any thoughtful comments below.

Sources:

Carlson, Joe. “OIG Finds Widespread Herceptin Overcharges.” Modern Healthcare. (January 21, 2013). From: http://www.modernhealthcare.com/article/20130121/NEWS/301219959/oig-finds-widespread-herceptin-overcharges

Jarmon, Glorida. “The Medicare Contractor’s Payments to Providers in Jurisdiction 9 for Full Vials of Herceptin were often Incorrect.” Office of Inspector General (January 2013). From: http://www.thehealthlawfirm.com/uploads/Herceptin%20FL%20Overcharges.pdf

About the Authors: Lance O. Leider is an attorney with The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Avenue, Altamonte Springs, Florida 32714, Phone: (407) 331-6620.

George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

“The Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A. – The Health Law Firm, a Florida professional service corporation, since 1999.
Copyright © 1996-2012 The Health Law Firm. All rights reserved.